Comparison Of Clinicopathological Features And Survival Of Malignant Hypertensive Renal Damage With Or Without Primary Nephropathy

BackgroundMalignant hypertension(MHT)is a group of clinical syndromes caused by primary or secondary hypertension,and is one of the most common clinical critical illnesses.Renal involvement occurs in 63-90% of MHT patients and acute renal failure is the main cause of poor prognosis.Relevant studies reported that the severity of renal damage was a key factor for the prognosis for MHT patients,and the renal damage in malignant hypertension were related to many factors.Up to now,there were not many researches on malignant hypertension.However,our study analyzed and compared the pathological,clinical data and follow up of patients with primary nephropathy or MHT renal damage.The survival of MHT renal damage patients with or without primary nephropathy were compared,and our study also showed that there were differences in clinicopathological features of patients with malignant hypertension with or without primary nephropathy.ObjectiveTo investigate the clinicopathological features and survival of malignant hypertensive renal damage with or without primary nephropathy in order to provide evidence for clinical treatment and prevention.MethodsA total of 42 patients(30 males,12 females)clinically diagnosed as malignant hypertension from January 2019 to December 2020 were enrolled in our study.Renal damage was confirmed by biopsy in all patients.The 42 patients were divided into experimental group(19 MHT patients with primary nephropathy)and control group(23MHT patients without primary nephropathy).The demographic characteristics and clinical data of the two groups were collected,including general condition(including age,gender,disease duration,etc.),present history and past medical history.All patients underwent pathological biopsy and pathological tissue examination.Of the 19 cases in experimental group,16 cases were primary IgA nephropathy,2 cases were primary focal segmental glomerulosclerosis(FSGS),and 1 case was primary membranous nephropathy.We analyzed and compared the clinicopathological features and survival of malignant hypertensive renal damage with or without primary nephropathy situation.Results1.There was no significant difference in gender,age,body mass index,family history of hypertension,and course of hypertension between the two group(P> 0.05).The Ratio of patients with ST-T segment change in experimental group(68.42%)was significantly higher than that in control group(56.52%)(P < 0.05).IgA level in the experimental group was significantly higher than that in the control group.The plasma albumin level in the experimental group was significantly lower than that in the control group.The 24 h urine protein and the incidence of non-uniform hematuria in the experimental group were significantly higher than that in the control group(P < 0.05).2.The clinical pathological data showed that the number of spheroid sclerosis,spheroid sclerosis ratio(≥50%),mesangial cell proliferation,endothelial cell proliferation,and crescent in the experimental group were higher than those in the control group.The proportion of glomerular ischemic shrinkage in the experimental group was significantly lower than that in the control group.The deterioration of renal interstitial fibrosis and renal tubular atrophy were significantly higher than those in the control group(P<0.05).There was no significant difference in onion skin lesions,hyaline degeneration,fibrinoid necrosis,microthrombus,arteriolar occlusion,and mucinous edema/degeneration between the two groups(P>0.05);the comparison of thrombus level in arteriolar cavity in experimental group was significantly higher than that in control group(P < 0.05).3.Among the 42 patients,19 patients were in the experimental group and 23 patients were in the control group.1 died of acute brain death,1 died of other malignant tumor,1died of traffic accident,and 3 were lost to follow-up.In this study,ESRD was used as the study end-point.Kaplan-Meier analysis showed that the cumulative renal survival time was(5.67±1.61)months in the experimental group and(9.41±2.62)months in the control group(P<0.05).The cumulative renal survival rate in the experimental group(11.6%)was significantly lower than that in the control group(53.33%)(P<0.05).ConclusionMore severe clinicopathology and shorter cumulative kidney survival time were found in malignant hypertension patients with primary nephropathy than without primary nephropathy,the latter aslo could lead to more renal failure and prevent the treatment of hypertension in clinical practice.Pay more attention to it in clinical practice.